Kevin Kronmiller

Extra innings

by Mollie McDowell

On Valentine’s Day, 2014 Kevin drove the 326 miles from his Mayo Clinic Jacksonville hospital room to a dress shop near Pensacola, FL where his daughter was trying on gowns for a school event. “I hadn’t seen my kids in almost six weeks. I walked in, and the looks on their faces—it was such a happy surprise. I never imagined I would live to see this day."

Earlier that month, Kevin had arrived in the Jacksonville emergency room with a fever and a terrible stomach ache. He was two weeks into life with a newly transplanted liver. He had been recovering surprisingly well at the recovery housing near the hospital. But on the morning of his ER visit, he laid in bed in excruciating pain, begging his wife to let him go to sleep. “Please get up. Do it for the kids,” she said, trying to get him to the ER. “I’d be dead without her,” he claims—and he’s right. Kevin was near death from severe sepsis, the body’s reaction to infection and one of the leading killers of patients in hospitals. Over 250K people die from the condition each year. His doctors later said Kevin’s chances for survival were about 30%. Sepsis is among the most expensive in-hospital conditions, costing the system $24B annually, and is incredibly difficult to detect and treat.

In 1986, at the age of 23, the center where Kevin donated blood caught an abnormality while testing his donation, which led to his diagnosis of primary sclerosing cholangitis, PSC, an autoimmune disorder that affects the liver and bile ducts. He was told he would need a liver transplant within five years. Without one he’d die. Against the odds, he did not become sick enough to need a transplant for nearly three decades.

"No words can describe the feeling that I get to be part of my kids' life, when it looked like I might not." (Mollie McDowell for Rock Health)

Soon after being released from the hospital, Kevin called Mayo to ask if he was healthy enough to go fishing with his kids. Most sepsis patients aren't so lucky. (Mollie McDowell for Rock Health)

Born near Pensacola, FL, where to this day he still lives together with his wife Brenda, a first-grade teacher, two high school-aged kids, and their Schnauzer mutt Bella, Kevin rises at 4am and commutes an hour and half daily to work as a computer scientist with the Air Force. He has an incredible ability to see the silver lining in everything. "The best thing about waiting so long for a transplant was that my wife and I could plan well in advance for the really expensive medical bills awaiting us. We saved money and lived off less than we had to." Kevin didn't let liver disease hold him back either. He ran in 10k races, played volleyball, and developed a love for deep sea and inshore saltwater fishing. "Some days I had to stay home from work, but I worked up until three days before my transplant.” Don't let this fool you—Kevin was persevering. “You don’t know how sick you are until you get better,” he says. “Before my transplant, ammonia would cloud my brain and I couldn’t think. I’m an engineer, I can do math in my sleep. My wife would ask me what 8+6 was to see if I was fit to go to work.”

Kevin, with jaundice, and his family before his transplant. "All of this was harder on my wife. She had to deal with helping me get better and figuring out what to do if I didn’t." (Photo courtesy of the Kronmiller family)

“In the ER that morning, Kevin’s chances for survival were about 30%.”

In the ER that January morning, he nearly coded—his heart rate “about stopped. I was close to checking out.” Sepsis often comes on suddenly, unexpectedly—and takes an incredibly precise treatment plan delivered by a team of skilled providers to beat. Even with skillful, attentive doctors, patients don’t survive in 30% of cases. For someone with severe sepsis, it’s closer to 60%. And survivors often face a grim future. After an average of two weeks in the ICU, many suffer from multi-organ failure, have lifelong medical conditions, like kidney failure, to treat. They might spend hours each week on a dialysis machine, or need to learn how to walk again after a limb amputation.

Most sepsis patients aren't calling their doctor to ask if they can go deep sea fishing, as Kevin was.

During our interview, a friend called Kevin to ask if he could help him move. “It’s so nice to be helpful. When I was sick, the feeling of helplessness could be so debilitating," he reflected. (Mollie McDowell for Rock Health)

The trouble with sepsis is that its signs can be elusive—and doctors and nurses must deliver precise, responsive, and specific medications to treat it—and timing is crucial.

Kevin had his transplant at the Jacksonville, FL branch of one of the leading hospitals in the US, the Mayo Clinic. Mayo had very recently integrated a new sepsis detection and treatment software called AWARE, by Ambient Clinical Analytics. Developed by Mayo’s own innovation team, AWARE electronically monitors all patients at risk of sepsis in a hospital—especially in the emergency room or intensive care unit (ICU). AWARE uses various algorithms to analyze a patient’s vital signs and can determine very quickly if they go into the range of sepsis—then alerts doctors. Once Kevin’s severe sepsis was detected, the tool triggered its treatment protocol, making sure fluids and antibiotics were given at very specific times in response to his status. Published research shows that electronic monitoring and decision support algorithms reduce sepsis mortality by 25% to 50% (1), (2). Kevin’s quick recovery is a testament to just how effective this can be.

"Ambient's tool reduced hospital charges by $43,745 per visit"

Ambient’s AWARE tool is based on analytics technology licensed from the Mayo Clinic and has received FDA Class 2 clearance, making it one of the few products considered "Software as a Medical Device.” The tool organizes relevant patient data, informs the best care options, and helps prevent errors. Research has shown that Ambient cuts the length of stay in the ICU in half and reduces errors by 50%—putting a dent in the nearly $49B that preventable medical errors cost our healthcare system each year. Ambient's tool also reduced the costs of hospital stays by 30%—or $43,745 per visit—a nontrivial amount.

Ambient also gives providers feedback in close to real time about how responsive they were to patients and how each patient reacted to treatments. This helps the hospital care team improve their care and patient outcomes. “Changing human behavior is really difficult. For quality improvement, this tool works because you’re able to provide [health care providers] with that feedback,” says Dr. Pablo Moreno—one of Kevin’s physicians at Mayo Clinic.

“You don’t know how sick you are until you get better.” (Mollie McDowell for Rock Health)

Kevin makes the most of the days he has been given. “I’m in extra innings," he says. "I want to go skydiving but Brenda thinks it’s too dangerous. We live on a small lake. We go kayaking and swimming. On the weekends, we have all our friends over—last week a friend was baptized on the lake.” He reflects, “I think I’m a better father after all this, and a better husband. My wife has been my rock. All of this was harder on her—she had to deal with helping me get better and figure out what to do if I didn’t.”

"A few months after I was home from my liver transplant, my kids said how glad they were to have 'Happy Daddy back.' It was bittersweet. It was hard to realize I had been 'Grumpy Daddy' for so long during my illness." This week, over three years after he surprised his daughter at the dress shop, Kevin donned a tuxedo and joined her again—this time to escort her on stage in front of the whole town for her senior homecoming court.

After a lifetime of planning for an early death, Kevin is coming to terms with setting new goals and expectations for his future. "When I was younger I never thought I'd live long enough to see my kids graduate. Now I'm looking at the possibility of being a grandfather." He's determined to make the most of his extra innings—and use them to serve others. Twice a year he goes back to Mayo Clinic for exams. “I always go up to the floor where I stayed and see some of the nurses and doctors who helped me—to thank them. This last time I saw a man who was so yellow from jaundice. I got to show him—‘this is what you get to expect.

There is life after this.'"

As he dons a tuxedo to escort his daughter at homecoming, Kevin confesses, "I never thought I'd live long enough to see my kids graduate. Now I'm looking at the possibility of being a grandfather." (Mollie McDowell for Rock Health)

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